Asthma is defined by airway inflammation and hyperresponsiveness, and contributes to morbidity and mortality worldwide. Although bronchodilation is a cornerstone of treatment, current bronchodilators become ineffective with worsening asthma severity. We investigated an alternative pathway that involves activating the airway smooth muscle enzyme, soluble guanylate cyclase (sGC). Activating sGC by its natural stimulant nitric oxide (NO), or by pharmacologic sGC agonists BAY 41-2272 and BAY 60-2770, triggered bronchodilation in normal human lung slices and in mouse airways. Both BAY 41-2272 and BAY 60-2770 reversed airway hyperresponsiveness in mice with allergic asthma and restored normal lung function. The sGC from mouse asthmatic lungs displayed three hallmarks of oxidative damage that render it NO-insensitive, and identical changes to sGC occurred in human lung slices or in human airway smooth muscle cells when given chronic NO exposure to mimic the high NO in asthmatic lung. Our findings show how allergic inflammation in asthma may impede NO-based bronchodilation, and reveal that pharmacologic sGC agonists can achieve bronchodilation despite this loss.A sthma is an inflammatory disease that causes airway hyperreactivity (AHR) and bronchoconstriction, which impedes daily life activities and, when severe, can cause death. It is the most common chronic disease of childhood, accounts for one in three emergency department visits daily, and asthma diagnoses are increasing worldwide (1). The leading treatment for relief and acute care is bronchodilation, which relies heavily on the β-adrenergic receptor-cAMP pathway. Nearly 70% of patients, however, develop resistance or tachyphylaxis to the existing β-agonist therapy (2), underscoring a need for new bronchodilators that can act through a different pharmacologic principle.The nitric oxide-soluble guanylate cyclase-cGMP pathway (NO-sGC-cGMP) is the primary signal transduction pathway for relaxing vascular smooth muscle (3). In contrast, a role for the NO-sGC-cGMP pathway in relaxing airway smooth muscle is less clear (4, 5), and bronchodilation was instead suggested to depend on glutathione nitrosothiol levels in the lung (6, 7). However, recent studies have shown that inflammation can desensitize sGC toward its natural activator, NO (8), and new drugs have become available that directly activate sGC, independent of NO (9). These developments encouraged us to re-examine the NO-sGC-cGMP pathway regarding its role in bronchodilation, its becoming damaged in inflammatory asthma, and its potential for alternative bronchodilator development under this circumstance.
ResultsThe NO-sGC-cGMP Pathway Bronchodilates Human Lung. We first tested if stimulating the NO-sGC-cGMP pathway would dilate preconstricted small airways in human precision-cut lung slices (PCLS) obtained from healthy donor lungs (Fig. 1A and Table S1). Graded doses of the slow-release NO donor DETA/NO [3,3-Bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene] produced bronchodilation in human PCLS similar to what was ...